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Dissociative Identity Disorder
| }} Definition Dissociative identity disorder is a diagnosis described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Revised, as the existence in an individual of two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. At least two of these personalities are considered to routinely take control of the individual's behavior, and there is also some associated memory loss, which is beyond normal forgetfulness. This memory loss is often referred to as "losing time". These symptoms must occur independently of substance abuse or a general medical condition. Description Dissociative identity disorder was initially named multiple personality disorder, and, as referenced above, that name remains in the International Statistical Classification of Diseases and Related Health Problems. While dissociation is a demonstrable psychiatric condition that is tied to several different disorders, specifically those involving early childhood trauma and anxiety, multiple personality remains controversial. Criticisms The problem is perhaps not multiple personalities, but rather a loss of identification with the individual recognizable personality. This results in tendancies to switch personalities with a much weaker conscious control, and sometimes with the conscious mind oblivious to the switching. The interpretation from the external view is a multiple persona, but internally the individual may not notice or understand the phenomena is occuring. Despite the controversy, some mental health institutes have wards specifically designated for dissociative identity disorder. DSM-IV-TR diagnostic criteria Due to copyright infringement issues and editorial concerns, the American Psychiatric Association has requested that specific reference to the DSM-IV-TR by Wikipedia be outlinked. The current diagnostic criteria for '''Dissociative identity disorder' published in the Diagnostic and Statistical Manual of Mental Disorders may be found here:'' [http://www.behavenet.com/capsules/disorders/did.htm DSM-IV-TR Diagnostic Criteria: Dissociative identity disorder (DID)] A definition of dissociation Dissociation is a complex mental process that provides a coping mechanism for individuals unable to escape painful and/or traumatic situations. It is characterized by a dis-integration of the ego. Ego integration, or more properly ego integrity, can be defined as a person's ability to successfully incorporate external events or social experiences into their perception, and to then present themselves consistently across those events or social situations. A person unable to do this successfully can experience emotional dysregulation, as well as a potential collapse of ego integrity. In other words, this state of emotional dysregulation is, in some cases, so intense that it can precipitate ego dis-integration, or what, in extreme cases, has come to be referred to diagnostically as dissociation. Dissociation causes various degrees of disintegration of ego integrity, and in more profound dissociation the personality is considered to literally break apart. Severe dissocation is often referred to as "splitting" or "altering". Less profound presentations of this condition are often referred to clinically as disorganization or decompensation. The difference between a psychotic break and a dissociation, or dissociative break, is that, while someone who is experiencing a dissociation is technically pulling away from a situation that s/he cannot manage, some part of the person remains connected to reality. While the psychotic "breaks" from reality, the dissociative disconnects, but not all the way. Because the person suffering a dissociation does not completely disengage from his/her reality, s/he may appear to have multiple "personalities". In other words, different "people" (read: personalities) to deal with different situations, but generally speaking, no one person (read: personality) who will retreat altogether. Symptoms Patients often have a remarkable array of symptoms that can resemble other neurologic and psychiatric disorders, such as anxiety disorders, personality disorders, schizophrenic and mood psychoses, and seizure disorders. Symptoms of this particular disorder can include: *depression *anxiety (sweating, rapid pulse, palpitations) *phobias *panic attacks *physical symptoms (severe headaches or other bodily pain) *fluctuating levels of function, from highly effective to disabled *time distortions, time lapse, and amnesia *sexual dysfunction *eating disorders *sleeping disorders (insomnia, sleepwalking, night terrors) *posttraumatic stress *suicidal preoccupations and attempts *episodes of self-mutilation *psychoactive substance abuse Other symptoms include: Depersonalization, which refers to feeling unreal, removed from one's self, and detached from one's physical and mental processes. The patient feels like an observer of his life and may actually see himself as if he were watching a movie. Derealization refers to experiencing familiar persons and surroundings as if they were unfamiliar and strange or unreal. Again, doctors must be careful not to assume that a client has MPD or DID simply because they present with some or all of these symptoms. Another factor in the diagnosis is the all squares are rectangles but not all rectangles are squares idea, which is to say that although many of these symptoms may be present in an individual, he or she may not necessarily have DID. For example, someone may have severe PTSD (one symptom) and self mutilate with suicidal ideas, which is 3 of the above symptoms, but will not have DID. In order for DID to be diagnosed, there must be 2 or more distinctly present personalities. Persons with dissociative identity disorder are often told of things they have done but do not remember and of notable changes in their behavior. They may discover objects, productions, or handwriting that they cannot account for or recognize; they may refer to themselves in the first person plural (we) or in the third person (he, she, they); and they may have amnesia for events that occurred between their mid-childhood and early adolescence. Amnesia for earlier events is normal and widespread. . . . . . . . . . . . ' : Epidemiology' * DID: Incidence * DID: Prevalence * DID: Morbidity * DID: Mortality * DID: Racial distribution * DID: Age distribution * DID: Sex distribution ' : Risk factors' * : Known evidence of risk factors * : Theories of possible risk factors ' : Etiology' * : Known evidence of causes * : Theories of possible causes ' : Diagnosis & evaluation' * DID: Psychological tests * DID: Assessment isssues * DID: Evaluation protocols ' : Treatment' * outcome studies * DID: Treatment protocols * DID: Treatment considerations * DID: Evidenced based treatment * DID: Theory based treatment * DID: Team working considerations * DID: Followup ' : For people with this difficulty' * DID: User:how to get help * DID: User:self help materials * DID: User:useful reading * DID: User:useful websites * DID: User:user feedback on treatment of this condition ' : For their carers' * DID: Carer:how to get help * DID: Carer:useful reading * DID: Carer:useful websites Causes/etiology Although many experts dispute the existence of this controversial diagnosis, Dissociative Identity Disorder has been attributed by some to the interaction of several factors: overwhelming stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiencesFirst Person Plural. Children are not born with a sense of a unified identity — it develops from many sources and experiences. In overwhelmed children, its development is obstructed, and many parts of what should have blended into a relatively unified identity remain separate. North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood and that abuse can be documented for 85% of adults and for 95% of children and adolescents with dissociative identity disorder and other closely related forms of Dissociative Disorders. Although these data establish childhood abuse as a major cause among North American patients (in some cultures, the consequences of war and disaster play a larger role), they do not mean that all such patients were abused or that all the abuses reported by patients with dissociative identity disorder really happened. Some aspects of some reported abuse experiences may prove to be inaccurate. Also, some patients have not been abused but have experienced an important early loss (such as death of a parent), serious medical illness, or other very stressful events. For example, a patient who required many hospitalizations and operations during childhood may have been severely overwhelmed but not abused, although parents helping people through these times can act as a preventative measure. Merck.com The Merck Manual. Human development requires that children be able to integrate complicated and different types of information and experiences successfully. As children achieve cohesive, complex appreciations of themselves and others, they go through phases in which different perceptions and emotions are kept segregated. Each developmental phase may be used to generate different selves. Not every child who experiences abuse or major loss or trauma has the capacity to develop multiple personalities. Patients with dissociative identity disorder can be easily hypnotized. This capacity, closely related to the capacity to dissociate, is thought to be a factor in the development of the disorder. However, most children who have these capacities also have normal adaptive mechanisms, and most are sufficiently protected and soothed by adults to prevent development of dissociative identity disorder. Treatment/management The most common approach to treatment aims to relieve symptoms, to ensure the safety of the individual, and to improve communication and co-operation between the different identities. In most cases it is possible for them to either integrate into one well-functioning identity or for them to reach a well-functioning collaborate working alliance. Both treatments follow the same three phrases as treatment for Complex PTSD. Treatment also aims to help the person safely express and process painful traumatic memories, develop new coping and life skills, restore functioning, and improve relationships. The success of treatment depends primarily on a strong therapeutic relationship, a safe therapeutic environment and appropriate boundaries (ISST-D.org) rather than the treatment modality. Stabilisation and integration of traumatic memories are essential aspects of treatment due to the fact the vast majority present with posttraumatic stress disorder, most have repeated suicide attempts and over 40% self-harm.Treatment Guidelines for Adults Treatment guidelines for DID and the similar condition Dissociative Disorder Not Otherwise Specified exist Information for Experienced Professionals for both Children and Adolescents, and separate guidelines for Adults (Treatment Guidelines for Adults) have been developed by the International Society for the Study of Trauma and Dissociation http://isst-d.org International Society for the Study of Trauma and Dissociation website), based on extensive research and expert advice. Phases of Treatment # Stabilization and Symptom Reduction # Working through and Processing Traumatic Memories # integration and rehabilitation Treatment Guidelines for Adults Treatment is likely to include some combination of the following methods: *PsychotherapyThe Psychoanalytic Psychotherapy of Dissociative Identity Disorder in the Context of Trauma Therapy ( Psychoanalytic Inquiry, 2000)International Psychoanalytical Association ( IPA ): This kind of therapy for mental and emotional disorders uses psychological techniques designed to encourage communication of conflicts and insight into problems. *Cognitive therapy: This type of therapy focuses on changing dysfunctional thinking patterns. *Medication: There is no medication to treat the Dissociative Disorders themselves. However, a person with a Dissociative Disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine. * Expressive therapy such as art therapy or music therapy: These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way. *Clinical hypnosis: This is a treatment technique that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness or awareness Memory work should not be done using hypnosis but it may be effective for self-soothing.Treatment Guidelines for Adults *Integrated Family Systems: This approach involves identifying and working with different self-states and acknowledging their roles. It has been shown to be effective in many different conditions, not just dissociative identity disorder. *Behavioral therapy: Cognitive behavioral therapy and Dialectic Behavioral Therapy have shown some effectiveness in the treatment of DID, especially in improving stability. *Ego-state therapy: Ego-state therapy is used to help non-dissociative individuals resolve conflicts among different parts of themselves (i.e. ego states); since DID is an extreme differentiation among ego states, some therapists find the approach useful in working with dissociative clients.Watkins, H. H. (1993)Ego-State Therapy: An Overview. American Journal of Clinical Hypnosis, 35 (4), pp. 232 - 240 ( Psychoanalytic Inquiry, 2000) Shocking/Fun Facts About Dissociative Identity Disorder * Dissociative Identity Disorder has similar symptoms to other disorders such as Schizophrenia. The symptoms of these two are homogeneous, which causes many people to be confused. Unfortunately, because of this, psychologists often mix up Schizophrenia and Dissociative Identity Disorder which causes most patients suffering from Dissociative Identity Disorder to go undiagnosed or misdiagnosed. Due to these complications, it takes an average of 7 years for a person to be diagnosed with Dissociative Identity Disorder. * A man was arrested for having sex with a woman who was diagnosed with Dissociative Identity Disorder because he did not get consent from all of the alters in the system. * Alters are able to live and interact in a virtual internal world which is commonly called "headspace". * Alters can be anything. * When one alter becomes two, it is called "splitting". When a new alter emerges on his own, it's called "popping". * Alters have a right to have separate representation in court if they are accused of a crime. * Alters can have relationships with each other and have sexual intercourse, which results in children that exist within the system. * Different alters can have different physical characteristics, such as blood type, eye color, allergies and sensory capabilities * Giving one alter medicine doesn't necessarily affect other alters. * Some alters claim to travel between systems (bodies). What much more likely happens is that an alter goes dormant in his system of origin and is copied into the new one. This is referred to as a "system jump". See also *Multiple personality controversy *Healthy multiplicity *Internal Family Systems Model *Repressed memory *Recovered memory therapy *Shirley Ardell Mason, a.k.a. "Sybil" *Split Personality *Subpersonality *Me, Myself & Irene References & Bibliography Key texts Books *Alderman, T. & Marshall K.(). Amongst Others:A self help guide to living with dissociative identity disorder. New Harbinger:Oakland CA *Mollon, P. (1996). Multiple selves, multiple voices:Working with trauma, violation and dissociation. Chichester:Wiley *Ross, C A (1994). The Osiris Complex:Case studies in Multiple Personality Disorder. University of Toronto Press:London *Sinason, V. (2002).Attachment, trauma & multiplicity:Working with Dissociative Identity Disorder. Brumer:Routledge Hove Papers Additional material Books * Aldridge-Morris, R. (1989) Multiple Personality : an exercise in deception. Hove and London: I.E.A. Papers *Google Scholar *Allison, R.B. (1974) A new treatment approach for multiple personalities. American Journal of Clinical Hypnosis, 17, 15-39. *Bliss, E.L. (1980) Multiple personalities: report of fourteen cases with implications for schizophrenia and hysteria. Archives of General Psychiatry, 37, 1388-97. *Ellason, J.W. & Ross, C.A. (1995). Positive and negative symptoms in sisociative identity disorder and schizophrenia:A comparative analysis. Journal of Nervous and Mental Disease, 183,236-241. * Manning, M.L., & Manning, R.L. (2007). Legion Theory: A meta-psychology. Theory & Psychology, 17, 839-862. Final draft External links *Piper A, Merskey H. The persistence of folly: A critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Can J Psychiatry 2004;49:592–600 *Piper A, Merskey H. The persistence of folly: A critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder. Can J Psychiatry 2004;49:678–83. *Putnam, Frank W., The Diagnosis and Treatment of Multiple Personality Disorder, Guilford Press, New York, 1989 * Ross, Colin. Dissociative Identity Disorder: Diagnosis, Clinical Features and Treatment of Multiple Personality, Second Edition, John Wiley & Sons, Inc, 1997. ISDN: 0471-13265-9 http://www.rossinst.com/didbk.htm *Multiple Personality Disorder: Fact or Fiction? Alexandria K.Cherry Rochester Institute of Technology *Guidelines for Treating Dissociative Identity Disorder in Adults (2005) James A. Chu, MD *Multiple Personality Disorder in the Courts Dr. David V. James MA, MRCPsych (UK) *Dissociative Identity Disorder(formerly Multiple Personality Disorder) Nami.org *Mental Health: Dissociative Identity Disorder (Multiple Personality Disorder) WebMd.com *''Multiple Identities and False Memories'' by Nicholas Spanos, 1996, ISBN 1-55798-340-2 *[http://www.skepdic.com/mpd.html Essay from the Skeptic's Dictionary] *International Society for the Study of Dissociation *Three faces of Eve *Mental Health Matters: Dissociative Identity Disorder *Sidran Foundation A nonprofit organization disseminating information concerning the treatment of trauma. * Kinhost.org - A wiki for persons with multiple personalities (multiples) and friends-of-multiples Voices of multiples *Amorpha: Collective Phenomenon Non-disordered multiplicity from an art and political viewpoint. *Astraea Articles and links exploring the idea of healthy, non-disordered multiplicity. *In Essence We Declare Example of a healthy self-identified multiple group's co-signed agreement to maintain responsibility and functionality. *The Layman's Guide to Multiplicity (non-disordered multiplicity resource, written and edited by multiples) *Pavilion Awareness taskforce for functional multiplicity. Educate the public, media campaigns correcting misportrayals of multiples as helpless victims, crazed killers, etc. *Livejournal -- Multiplicity A large community for all views -- personal experience, opinion, discussion, debate. *Pilgrim's Journey A blog written by a young woman who experiences Dissociative Identity Disorder. *Psych Forums: DID Forum *Not Otherwise Specified is an autobiography of a woman who experiences Dissociative Identity Disorder Not Otherwise Specified (DIDNOS) and her process of being integrated. : Academic support materials * DID: Academic: Lecture slides * DID: Academic: Lecture notes * DID: Academic: Lecture handouts * DID: Academic: Multimedia materials * DID: Academic: Other academic support materials * DID: Academic: Anonymous fictional case studies for training Category:Dissociative disorders